Background: Listening and communication are two critical aspects of
positive relationships. In the context of health care, they have been
found to have a positive impact on many aspects of client care,
including patient satisfaction, emotional wellbeing, and functional and
physiological status. However, little is understood about the specific
listening and communication styles exhibited by students enrolled in the
health-related disciplines, including occupational therapy. The aim of
this study was to investigate the listening and communication styles of
undergraduate occupational therapy students.

Method: This was a cross-sectional study of 210 students (response
rate of 95.5%) enrolled in a Bachelor of Occupational Therapy (BOT)
course, who completed paper-based versions of the Listening Styles
Profile (LSP) and the Communicator Style Measure (CSM). Both the LSP and
CSM are valid and reliable measures.

Results: Participants reported a strong preference for the People
listening style and the Friendly and Attentive communication styles. A
moderate preference was also shown for the Content listening style.
There were only two minor differences between participants enrolled in
the different year levels of the BOT course, and only minor differences
between the male and female students.

Conclusion: The participants' reported preferences are well
suited for the role of occupational therapy. The findings suggest that
occupational therapy students exhibit a disposition towards listening
and communication styles that are indicative of an underlying interest
in the care and welfare of others and which are traits of the
'helping, people-oriented' professions. The implications of
these findings are that it is important to consider the listening and
communication styles of occupational therapy students during their
professional education and while completing practice placement
education.

Communication and listening are essential components in promoting
positive relationships between people. In the medical, nursing and other
health-related professions, poor communication has been a concern for
some time (Stewart 1995, Van Ess Coeling and Cukr 2000). Consequently,
the issue of communication has been studied often, particularly in
relation to medicine and nursing. However, little research has been
conducted into the communication styles demonstrated by students
completing courses in other health-related disciplines (including
occupational therapy), where it is no less important an issue. Effective
listening, in particular, has been found to improve patient
satisfaction, emotional health, functional and physiological status, and
pain control (Weaver and Kirtley 1995, Trahan and Rockwell 1999). The
benefits of communication have been similarly noted (Kaplan et al 1989,
Van Ess Coeling and Cukr 2000, Ambady et al 2002). The importance of
listening and communication in achieving the desired outcomes in
occupational therapy, therefore, makes it worth ensuring that
occupational therapy students are well equipped to listen and
communicate effectively with patients and co-workers. The purpose of
this study was to investigate the listening and communication styles of
undergraduate occupational therapy students.

To explore listening styles, the Listening Styles Profile (LSP) has
been used previously (Watson et al 1995). The LSP measures four
listening styles: People, Action, Content and Time. It has been found
that most people adopt a preference for a particular combination of
listening styles. This is important because one's listening style
tends to be a function of habit rather than a considered use of the most
appropriate style for the situation (Watson et al 1995). Accordingly,
the LSP will give an indication of how participants will listen when on
the job and in social situations. The People listening style is
characterised by an awareness of, and concern for, the feelings of
others. The Action listening style is characterised by a desire for
precise, error-free presentations, and frustration with disorganised
presentations. The Content listening style is adopted by those who like
to consider facts and details closely. Finally, the Time listening style
is adopted by those who are conscious of the time while listening and
often prefer brief and hurried interactions.

Considering communication more broadly, the Communicator Style
Measure (CSM) has been used to explore the preferred styles of
communication used by individuals (Norton 1978). The CSM measures 10
different communication styles, which Norton (1978) described as
'the way one verbally and paraverbally interacts to signal how
literal meaning should be taken, interpreted, filtered, or
understood' (p99). The 10 styles are described as follows. The
Dominant communication style is characterised by a desire to take
control of conversations. Dramatic involves exaggerating, understating
and otherwise stylising one's conversation. Contentious is
characterised by being argumentative. The Animated style involves using
many non-verbal physical cues, such as hand gestures or nodding. The
Attentive style involves letting one's conversation partner know
that he or she is being listened to. Impression Leaving is a memorable
style of communication. Relaxed is characterised by a lack of anxiety
when communicating. Open is characterised by being affable, unreserved,
extraverted and approachable. Friendly ranges from not being hostile
through to deep intimacy. Finally, Precise involves a focus on accuracy
and detail in conversations.

A person is found to have not one communication style but, rather,
preferences for different combinations, to the extent that Norton (1983)
suggested that the styles are multicollinear. In developing the CSM,
Norton (1978) described six clusters of communication styles that group
together statistically and conceptually. These were combinations of
communication styles that were likely to be found together. For
instance, the Dramatic and Animated styles were found to cluster
together. Studies using the CSM have not limited themselves to
communication styles outlined by Norton, either. Buller and Buller
(1987) grouped the CSM's items into two groups called Affilitative
and Dominance when analysing the communication styles of a cohort of
physicians. The Affilitative style, characterised by a desire to
establish positive patient-physician relationships, was found to have a
positive relationship with patient satisfaction. In contrast the
Dominance style, which was characterised by the physician maintaining
control over the physician-patient relationship, was negatively related
to patient satisfaction.

Method

Design

This was a cross-sectional study using paper-based versions of the
Listening Styles Profile (LSP) and the Communicator Style Measure (CSM),
which were administered to a cohort of undergraduate occupational
therapy students.

Participants

All students (n = 220) enrolled in the Bachelor of Occupational
Therapy (BOT) course at Monash University were eligible to participate.

Instrumentation

The LSP is an instrument designed to assess four styles of
listening: People, Action, Content and Time. It consists of 16 items
rated on a five-point rating scale (0 = Never, 1 = Infrequently, 2 =
Sometimes, 3 = Frequently, 4 = Always). The higher the reported score,
the higher is the participant's preference for that style. The LSP
score range is 0 to 20. Examples of the LSP items are located in Table
1. The internal consistency for the LSP's four constructs as
measured by Cronbach's alpha, reported by Watson et al (1995), were
People ([alpha] = 0.62), Action ([alpha] = 0.64), Content ([alpha] =
0.58) and Time ([alpha] = 0.65). In the original development of the LSP,
a test-retest found the scale to be stable over a 2-week period (Watson
et al 1995). Evidence of the content validity and construct validity of
the LSP have been reported (Watson et al 1995).

The CSM is an instrument designed to assess 10 styles of
communication and one's perception of their communication ability
(Norton 1978). The instrument consists of 51 items; however, once the
filler items and items related to communication image, which are not
relevant to this study, are set aside, each communication construct
consists of four items. These are rated on a five-point rating scale
(YES! = 5, yes = 4, ? = 3, no = 2, NO! = 1). Three items were reversed
for analysis. The constructs derived from the CSM have scores ranging
from 4 to 20, with higher scores indicating a stronger preference for
that communication style. The internal consistency, as measured by
Cronbach's alpha for each of the CSM's subscales, was reported
by Norton (1978) as follows: Friendly ([alpha] = 0.37), Impression
Leaving ([alpha] = 0.69), Relaxed ([alpha] = 0.71), Contentious ([alpha]
= 0.65), Attentive ([alpha] = 0.57), Precise ([alpha] = 0.52), Animated
([alpha] = 0.56), Dramatic ([alpha] = 0.68), Open ([alpha] = 0.69) and
Dominant ([alpha] = 0.82). Examples of the CSM items are located in
Table 1. The CSM also has established content validity and construct
validity (Graham 2004).

Procedure

Ethics approval was obtained from the Monash University Standing
Committee on Ethics in Research Involving Humans (SCERH). At the
conclusion of a lecture, occupational therapy students were invited to
participate in the study. Students were provided with an explanatory
statement and were informed that participation was voluntary and
anonymous. A non-teaching member of staff facilitated the process and
participants completed a questionnaire containing the LSP, CSM and a
brief set of demographic questions. It took approximately 10 minutes to
complete both questionnaires and participant consent was implied by
completion of the questionnaire. The data were analysed on a group
basis, therefore no individual participants were identifiable.

Data analysis

The Statistical Package for the Social Sciences (SPSS, Version
17.0) was used for data storage, tabulation, and the generation of
descriptive statistics. Medians were used to describe the data, and the
non-parametric Mann-Witney U test and Kruskal-Wallis test were used to
explore differences in preferences between the genders and the year
level in which the student was enrolled (for example, first, second,
third or fourth years). The results were considered statistically
significant if the p value was < 0.05.

Results

Demographics

A total of 210 students participated in this study (response rate
of 95.5%). A large number of participants were enrolled in the first
year (n = 85), but there was also a reasonable representation of
students from the second year (n = 35), third year (n = 38) and fourth
year (n = 52). The vast majority of participants were female (90.0%) and
the participants were almost all either under 21 years of age (54.0%) or
between 21 and 25 years of age (42.2%). The gender and ages of the
sample were consistent with the actual demographic profile of the
students enrolled in the BOT course. The sample consisted of 21 male and
189 female students.

Listening styles

As shown in Table 2, participants showed the strongest preference
for the People listening style. A moderate preference was shown for the
Content listening style and little to no preference was exhibited for
the Action and Time listening styles. A Mann-Witney U test found a
statistically significant difference in the preference for the People
listening style between males (Md = 3.00, n = 21) and females (Md = 3.5,
n = 189), U = 1207.5, z = -2.981, p = 0.003, r = 0.21. The same test
found no significant differences between the two genders for either the
Action (p = 0.532), Content (p = 0.571) or Time (p = 0.764) listening
styles.

A Kruskal-Wallis test found a statistically significant difference
between students enrolled in the different year levels of the BOT course
(first, second, third or fourth year) and their preference for the Time
listening style %2 (3, n = 210) = 10.715, p = 0.013. Those participants
enrolled in the third year (Md = 1.25, n = 38) had a significantly lower
preference for the Time style than those enrolled in the first year (Md
= 1.75, n = 95), second year (Md = 1.75, n = 25) or fourth year (Md =
1.63, n = 52) of the BOT course. No statistically significant
differences were found between students enrolled in different year
levels of the BOT course and their preferences for the People (p =
0.202), Action (p = 0.235) or Content (p = 0.786) listening styles.

Communication styles

Participants showed the strongest preference for the Friendly
communication style, followed by the Attentive and Animated styles.
Participants reported the least preference for the Relaxed, Contentious
and Dominant communication styles. The complete list, including medians,
is presented in Table 3. Using a Mann-Witney U test, a statistically
significant difference in the preference for the Animated communication
style was found between males (Md = 13.0, n = 20) and females (Md =
15.0, n = 188), U = 1105.0, z = -3.065, p = 0.002, r = 0.21. There were
no statistically significant differences between the genders for any of
the other communication styles.

To analyse differences between the year levels, a Kruskal-Wallis
test was conducted, which found a statistically significant difference
in the preference for the Precise communication style [chi square] (3, n
= 208) = 11.315, p = 0.010. Students enrolled in the third year (Md =
11.0, n = 37) reported a significantly lower preference for this style
than students enrolled in the first year (Md = 13.0, n = 95), second
year (Md = 13.0, n = 24) or fourth year (Md = 13.0, n = 52) of the BOT
course. No statistically significant differences were found between
occupational therapy students enrolled in the different year levels of
the BOT course for any of the other communication styles.

Discussion

The strongest preference among the undergraduate occupational
therapy student group was the People listening style. This style is
characterised by an interest in and concern for those one is listening
to. A significant difference in the preference for the People listening
style was found between the genders, with female students having a
slightly stronger preference for this style than male students; however,
it should be noted that the effect size was small (r = 0.21). Thus,
while a significant difference was found, limited weight should be
placed on this finding. The other listening style for which occupational
therapy students exhibited a moderate preference was the Content style,
which is characterised by a strong interest in the facts and details.

A strong preference for the People listening style is consistent
with the career choice that this cohort of students has made. The People
listening style is characterised by awareness and concern for the
feelings and emotions of others (Watson et al 1995, Chesebro 1999).
Those people with a dominant People listening style attempt to establish
common interests and to empathise with their clients. They are also
likely to have sympathetic tendencies (Weaver and Kirtley 1995).
Consistent with these findings, the People listening style has been
found to have a strong correlation with the Feeling type on the
Myers-Briggs Type Indicator (MBTI) (Worthington 2008). Feelers are
described as sympathetic, personable and friendly. It should be noted
that concern for the emotions of others does not imply that these people
are compelled to feel these emotions. They do, however, feel compelled
to achieve conversational goals and maintain relationships (Villaume and
Bodie 2007).

Pursuing a career in occupational therapy necessarily means that
the focus of occupational therapists' role is to take an interest
in the welfare and care of their clients in an effort to improve their
lives through occupation. A strong preference for the People listening
style is consistent with the career choice that this cohort of students
had made. That there were no statistically significant differences
between the year levels that the students were enrolled in and their
preference for the People listening style would suggest that the BOT
course has no direct impact on their preference for any specific
listening styles. Instead, it appears that individuals who are
interested in entering a people-focused, helping-oriented discipline,
such as occupational therapy, already have a disposition toward the
People listening style. It is likely that the People listening style is
refined and developed during the 4 years of the BOT course, with
increased exposure to different client groups though practice education
opportunities and academic education activities (for example, learning
to take a medical, social or developmental history from a client) where
astute listening skills are required.

Students demonstrated a low preference for the Time listening
style, which is characterised by a continual awareness of the time when
listening to someone, and the Action listening style, which is similarly
characterised by a desire to listen to brief, concise and accurate
presentations. It is a good finding for future occupational therapists
to report a low preference for the Time and Action styles. There are
times when it is important to hurry someone, or to have a need to act
quickly on accurate information, but these situations generally do not
lend themselves to being client centred. A significantly lower
preference for the Time listening style was found between students
enrolled in the third year and those enrolled in the other three year
levels.

Turning now to the communication styles, occupational therapy
students showed a strong preference for the Friendly style, followed
closely by the Attentive style. A strong preference for these styles is
consistent with the preference reported earlier for the People listening
style. The Friendly style is characterised by an approach that is
anything from not showing any hostility through to deep intimacy. The
Attentive style involves ensuring that one's conversation partner
is aware that he or she is being listened to. This can be as simple as
nodding in agreement while someone is speaking. Norton (1978) considered
the Friendly and Attentive styles to cluster together, which the results
of this study support; that is, someone who has a strong preference for
the one style generally has a similarly strong preference for the other
style. In the role of occupational therapist, a strong preference for
these two styles is significant for the same reason that a preference
for the People listening style is important --occupational therapy is a
caring profession and, therefore, requires practitioners who have an
interest in other people. Again, no difference was found between the
year levels and their preference for either of these styles, so it can
also be concluded that students with a disposition toward the Friendly
and Attentive communication styles are drawn to the occupational therapy
field since these traits are often used during practice.

Infante et al (1996) found that an argument was received better if
an affirming tone was used, which is characterised by the Attentive,
Friendly and Relaxed communication styles. Van Ess Coeling and Cukr
(2000) found better perceptions of collaboration between nurses and
physicians who adopted a strong preference for the Attentive style.
Infante and Gorden (1989) also found superiors to have a greater level
of satisfaction with subordinates when an Affirming style was used.
Similarly, Baker and Ganster (1985) found that subordinates were more
satisfied when their superiors had stronger preferences for the Open,
Friendly, Relaxed and Attentive communication styles. In another study,
that by Norton and Pettegrew (1979), respondents reported that they were
more physically attracted to a person who was perceived to exhibit the
Dominant and Open styles. These studies are all consistent in showing
that the communication style is important in how one relates to, and is
perceived by, others.

Occupational therapy students exhibited little preference for the
Relaxed, Contentious and Dominant communication styles. To reiterate,
the Relaxed style is characterised by a lack of anxiety when
communicating, the Contentious style is characterised by a tendency to
be argumentative, and the Dominant style is characterised by a tendency
to take the control of the conversation. It is unfortunate that
participants showed little preference for the Relaxed style. It would be
beneficial for occupational therapy students not necessarily to be
relaxed, but to be less anxious than this result indicates. Their lack
of preference for the Contentious and Dominant styles is consistent with
the findings discussed above, and is appropriate for therapists being
members of multidisciplinary health care teams who provide services for
the role of occupational therapist.

The analyses by year level found third-year students to have a
significantly lower preference for the Precise communication style, such
that it is on a par with the other least preferred communication styles.
No explanation can be provided for why third-year students have a
statistically significant difference in their preference for this style.
It is unlikely to be a result of their education, as fourth-year
students are consistent with first-year and second-year. The other
difference found in the participants' communication styles was the
greater preference for the Animated communication style among females in
comparison to males. A higher preference for the Animated style among
females is found elsewhere (Montgomery and Norton 1981). For the most
part, however, gender differences in this study, and in other studies
with regard to their self-reported communication styles, have been
minimal (Staley and Cohen 1988).

Studies using the CSM have also found that gender and ethnicity are
very weak factors in explaining differences in participants'
perceptions of their communication styles (Montgomery and Norton 1981,
Gudykunst and Lim 1985, Staley and Cohen 1988). These similarities are
likely to be a function of the CSM asking for participants'
perceptions rather than measuring actual communication styles. For
instance, a study that analysed the taped interactions between patients
and physicians in a number of clinical settings found significant
differences between how male and female physicians communicated, with
female physicians talking longer and engaging in more positive talk than
male physicians (Roter et al 1991).

Limitations of the study and recommendations for future research

A limitation of this study is the use of self-report measures.
There are differences between people's perceptions of themselves
and how they actually behave. In analysing gender differences, Staley
and Cohen (1988) found little difference in how the two genders perceive
their communication styles, but reported earlier results showing
considerable actual differences in communication styles between men and
women. Accordingly, caution is required in the interpretation of the
findings of this study because they are self-reported. Nevertheless,
these data provide a valuable insight into the listening and
communication styles of undergraduate occupational therapy students.
Another limitation is that participants were recruited from university,
hence the results can only be generalised to groups with similar
characteristics.

This study included only occupational therapy students and not
working professionals. Kiewitz et al (1997) suggested that the pressures
of the workforce may affect the preferences people have for either
listening or communication styles. Thus, while the results of this study
reliably present the preferences of this cohort of undergraduate
students, they can only be used as a guide as to how the students will
listen and communicate when in the workforce. It would be interesting to
follow this up with a longitudinal study to see whether the transition
from student to working professional does, in fact, have such a
considerable impact on people.

Recommendations for future research include replicating this study
with a larger group of occupational therapy students from other
university programmes, and comparing the listening and communication
styles of occupational therapists who work in different areas of
practice (for example, paediatrics, mental health and physical
disabilities) and in different practice settings (for example, acute
care hospitals, rehabilitation centres, community health centres,
schools, private industry/practice and early intervention centres).
Another suggestion would be to compare the listening and communication
styles of occupational therapists in cross-cultural contexts (for
example, to compare the listening and communication styles of therapists
working in different countries).

Conclusion

Overall, participants showed a preference for a combination of
listening and communication styles, which is well suited for the
profession of occupational therapy. A strong preference for the People
listening style and the Friendly and Attentive communication styles
augurs well for their engagement with clients when they begin practising
as occupational therapists. It should also be kept in mind that the
results of this study show how participants perceive themselves, and not
necessarily how they actually behave. Further research into how their
perception and behaviour correlate, or how their perception changes when
they make the transition from student to professional, would yield
valuable insights for use in guiding course curriculum and continuing
professional development needs.

Key findings

* Undergraduate occupational therapy students exhibited a strong
preference for the People listening style and the Friendly and Attentive
communication styles.

* Occupational therapy students demonstrated a preference for a
combination of listening and communication styles, which is well suited
for interacting with clients, their families and other professionals.

* Listening and communication skills of occupational therapy
students should be monitored during their academic education and when
they are completing practice education placements.

What the study has added

This study has increased our knowledge about the listening and
communication styles of occupational therapy students. The study has
also demonstrated a method for obtaining information about
students' self-perceptions in relation to the professional skills
they will need once they start to work with clients.